COPD合并继发性慢性肾上腺皮质功能减退患者的肾上腺皮质激素治疗方案探讨——附60例报告

目的：探讨COPD合并继发性慢性肾上腺皮质功能减退患者的肾上腺皮质激素治疗方法。方法：60例COPD急性加重期合并继发性慢性肾上腺皮质功能减退患者随机分为激素逐渐减量组（A组）和非激素逐渐减量组（B组）各30例，同期选取16名健康志愿者作为对照组。分别检测3组入院时、出院后第3个月、第6个月、第9个月、第12个月、第15个月、第18个月的血浆皮质醇水平，记录18个月观察期内A组、B组急性加重发作的次数及激素的总用量，比较上述指标的差异。结果：A组血浆皮质醇水平于出院后第12个月恢复正常，B组在18个月观察期内血浆皮质醇水平一直低于对照组。A组18个月内急性加重发作（0．7±0．3）次，明显少于B组的（4．7±1．3）次（P〈0．01）；A组18个月内泼尼松总用量（2055±310）mg，明显少于B组的（2675±518）mg（P〈0．05）。结论：对于COPD合并继发性慢性肾上腺皮质功能减退患者，宜在控制COPD急性加重期症状后，逐渐减少激素的用量并长期维持，以减少急性加重的发作次数和激素的总用量。动态测定血浆皮质醇水平有利于及时了解COPD合并继发性慢性肾上腺皮质功能减退患者的肾上腺皮质功能。

The exploration of corticoid therapeutic regimen in patients with chronic obstructive pulmonary disease complicated with second chronic adrenocortical hypofunction

Objective： To explore the corticoid therapeutic regimen in patients with chronic obstructive pulmonary disease（COPD） complicated with second chronic adrenocortical hypofunction. Methods： Sixty patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） complicated with second chronic adrenoeortical hypofunction were divided into gradually decreasing glucoeortieoid group （ group A, 30 patients） and non-gradually decreasing glucocorticoid group （group B, 30 patients） at random, and 16 healthy adults as control group. For 3 group subjects, the plasma corticosteroid levels were detected when they were to be in hospital and at 3rd month, 6th month, 9th month, 12th month, 15th month and 18th month after leaving hospital, respectively. For group A and B patients, the frequencies of AECOPD and total doses of glucocorticoid were calculated during 18 months, and the differences between them were compared. Results： The level of plasma corticosteroid in group A returned to normal range at 12th month, but the level of plasma corticosteroid in group B were constantly lower than normal range during 18 months. During 18 months, the frequencies of AECOPD in group A（0. 7 ± 0. 3 ）were significantly less than in group B（4. 7 ± 1.3） （P 〈 0. 01 ）, and total doses of prednisone in group A（2 055 ± 310） mg were significantly less than in group B （2 675 ± 518 ） mg （P 〈 0. 05 ）. Conclusion： For the patients with COPD complicated with second chronic adrenocortieal hypofunction, the dose of glucocorticoid gradually decreases, and then chronically maintains after controlling the symptome of AECOPD, which can decrease the frequencies of AECOPD and total doses of glucocorticoid. Dynamical mensuration of plasma cortieosteroid is beneficial to promptly to monitor the function of adrenal cortex in patients of COPD complicated with second chronic adrenocortieal hypofunction.